Adelaide PBL Bachelor of Dental Surgery Curriculum

Professor Grant Townsend
Faculty of Dentistry

Overall we aim to produce graduates who can practise as oral physicians in the 21st century, with the ability to communicate effectively, self evaluate, and diagnose and formulate treatment plans of varying complexity, as well as provide a range of treatment procedures for patients.

Description | Reasons for Change | Major Objectives of the Adelaide BDS Curriculum | Course Details | Evaluations | Contact

Description

A philosophy centred around student self-directed learning (SDL), problem-based learning (PBL) and contextual learning pervades the entire course. Our goal is to provide a course that is centred around the professional context for development of clinical reasoning skills, is intellectually stimulating and an enjoyable experience for students and staff. We strive to promote a desire in students to continue learning after graduation and to equip them accordingly. The new five-year PBL-based Bachelor of Dental Surgery (BDS) curriculum at the University of Adelaide commenced in 1993 and was implemented progressively, one year at a time, with the first cohort of students graduating at the end of1997.

 

Reasons for Change

A new BDS curriculum based on a PBL philosophy was introduced by the Faculty of Dentistry for various reasons, including an explosion of knowledge in dentistry leading to new philosophies, new techniques and on-going controversies, major changes in the patterns of dental disease, and an increasing proportion of the population who are retaining their teeth.

 

Major Objectives of the BDS Curriculum

The following objectives have formed the foundation of the new curriculum:

• to develop a more flexible curriculum structure, one that can respond rapidly to, and reflect, developments in the science and practice of dentistry.
• to provide a core experience for all students, supplemented by elective options (referred to as selectives), enabling degrees to be customised to some extent,
• to facilitate greater opportunities for contextual learning. We have moved away from the traditional model where most of the basic and applied science material was presented in the early years. This material was often not reinforced later in the course where its relevance would have been appreciated more by students. A greater integration, balance and flow of material throughout the course is an important objective.
• to introduce problem-based learning throughout the course so that students (and later graduates) are able to better integrate material and apply their knowledge, have improved clinical reasoning and communication skills, and have developed skills necessary for continued learning post-graduation
• to reduce formal contact hours for teaching and provide greater opportunities for self-directed, experiential learning throughout the course
• to make greater use of developments in computer-aided learning, audio-visual material and laboratory-based technique exercises
• to develop a course that students find stimulating and enjoyable, and one that engenders life-long learning.

 

Course Details

A relatively small number of streams integrated both horizontally and vertically over the five years of the course have replaced the previous large number of separate subjects. This change has been linked to a reduction in formal contact hours and greater co-ordination in the presentation and assessment of material. Students are introduced to dental scenarios from day one and have hands-on experience of many aspects of clinical dentistry during their first year.

Major Streams

Major Streams Figure 1. Major streams of the Adelaide BDS curriculum.

The new course at Adelaide employs a variety of teaching methods within a PBL philosophy, including resource lectures, interactive class meetings, problem-based sessions, laboratories and clinic sessions.

Assessment

The method of assessment of students forms a very important component of our BDS model. Assessment of students' performance takes many forms, including practical and tutorial assignments, workbooks, group projects, practical exercises, oral presentations, written examinations and end-of-year interviews (viva voce examinations). Exams are integrated and problem-based. Student self-assessment is encouraged and students are required to keep journals of reflection. The assessment procedures aim to:

• provide students with opportunities to demonstrate application of knowledge, attitudes and skills, not just recall of information.
• test for problem resolution and management as important aspects in justifying decisions, as well as the use of basic science information.
• encourage students to monitor their own performance as an essential part of their education.

Dental Learning Packages

A series of clinically-based situations, referred to as Dental Learning Packages (DLPs), is the main PBL format used in the curriculum. The DLPs are timetabled during class meetings in the Dental and Health Science stream. They aim to provide a realistic context for student learning and have been designed to integrate and coordinate with material presented in the other streams. For example, DLP 1.4 presents patients with either genetic or environmental enamel defects to introduce students to the timing and sequence of tooth development at the same time as they are studying genetics in the Human Biology stream. DLP 2.6 which presents issues of risk factors associated with periodontal disease by describing a patient with undiagnosed diabetes, is discussed while students are studying the biochemistry of energy metabolism in Dental and Health Science II and risk factors for periodontal disease in Dental Clinical Practice II.

Generally, DLPs consist of two parts that are discussed over two to three weeks and follow standard PBL process. During Part 1, students interact using variable group dynamics, with staff facilitating, and identify areas for independent study. Following discussion of areas that have been identified in Part 1, students work through Part 2, using the information gained from their own study. The sessions conclude with a review of the package.

The DLPs were initially presented in paper format only but we are now adapting them to video and CAL modules. For example, DLPs 1.3, 1.4 and 2.1 have been converted to CAL modules and DLPs 2.4, 2.5, 2.7, 3.2 and 3.3 use video triggers.

Journals

The creation of sound self-judgement for students is an integral goal in any educational sphere, but particularly in dentistry because of the "hidden" nature of dental procedures. The student clinicians must learn sufficient skills to accurately self-assess their performance, because following graduation this is the most commonly available assessment. A sound development of self judgement is the beginning of life-long learning. The journal serves many roles by providing:

• a reflective process, an essential part of the Kolb learning cycle;
• an outlet for personal feelings, especially anxiety;
• a time for feedback about a student's progress and hence assessment;
• feedback to the teacher concerning, e.g., the course assessment procedures, changes needed and course content;
• a precis of the year's work that can be used for further study or revision;
• a scientific basis for the learning process.

The roles of the journal are presented to students in their first week of first year as part of their introduction to the new course. This General Studies unit, Communication and Learning, is based around a dental clinical problem that aims to improve group interaction, begin to develop group process skills, reduce anxiety, boost confidence, begin to develop clinical reasoning, knowledge and skills, increasing students awareness of their own learning as well as introducing students to a journal of reflection (Wetherell and Mullins, 1996). Each students is expected to keep a journal, which is read by staff involved in Communucation and Learning.

After being introduced to the concept of journals, students are then required to keep them throughout the remainder of the course. The journals relate particularly to the Dental Clinical Practice stream, but students are encouraged to record and analyse their experiences relating to each of the streams. The journal helps formalize the reflective process and provides a process of continuous self-examination, that seeks to provide deeper and more meaningful learning, by converting experience into knowledge.

 

Evaluations

Since the introduction of the new curriculum, surveys have been routinely distributed to students at the end of each semester to obtain anonymous feedback on their perceptions of the new course in general (Wetherell, Mullins, Winning and Townsend, 1996), as well as the dental learning packages (Winning and Townsend, 1995) and journals of reflection (Wetherell and Mullins, 1996). They are asked to indicate their view of the BDS course, on a five-point scale (5-strongly agree to 1 - strongly disagree).

Students' perception of the workload in the 'new' curriculum was that it was reasonable (3.3 ± 0.60) with some increase in workload in second (3.6 ± 0.51) and third year (3.9 ± 0.64). Students in the 'new' curriculum indicated that for them the balance between theory and application was good (3.0 ± 0.54 for first year, 3.3 ± 0.48 for second year and 3.0 ± 0.55 for third year).

DLPs

DLPs were evaluated at the end of each semester in 1994 and 1995. Using the same scale described above, students were requested to indicate whether they considered they were taking responsibility for their own learning and whether they appreciated the relevance of DLP content to their future careers. Students agreed that they were taking responsibility for their own learning (4.2 ± 0.68 for first year and 3.7 ± 0.91 for second year). Similar results were found in response to their perception of the relevance of DLPs to their future careers (4.3 ± 0.83 for first year and 3.7 ± 0.91 for second year).

Journals of Reflection

At the end of each year students are asked to indicate what they believe are the main advantages and disadvantages of keeping a journal. They are asked also to list any problems they have experienced in keeping a journal and how these problems could be resolved. Finally, students are asked to rate the value of keeping a journal as a learning experience.

For first and second-year students, 40.7% considered the journals were valuable, 37% satisfactory, and 24.4% considered they were of limited value/no use. Most of the students (98%) considered that the journals gave them an opportunity to provide feedback to teachers about their teaching and course content.

Approximately 85% of students felt that the journals provided an opportunity for reflection and served as a source of feedback about their progress. 63% of students felt the journals were important as a summary of the year's work for revision, while 81% believed they were very important or at least of some importance in providing an insight into how one can learn.

It is impossible for educators to teach students everything they need to know. Curricula that are flexible and encourage students to take responsibility for their own learning and engender life-long learning are required. We believe that if students enjoy their undergraduate experience at dental school and have developed an ability to self assess and apply the PBL skills they have learnt throughout their course, they are more likely after graduation to become competent oral physicians who can keep pace with a rapidly expanding body of knowledge.

Graduates and their employees

We have recently completed a survey of the first cohort of graduates from the new curriculum (Greenwood, Mullins, Townsend, Wetherell and Winning, 1999). A questionnaire derived from a list of adjectives formulated by the UK General Dental Council was administered to new graduates and their employers after six months of practice. Responses were obtained from 31 of the 39 graduates and their employers. The graduates were rated as demonstrating good or very good levels of performance by more than 80% of their employers for 12 of 17 objectives. Over 96% of employers rated the graduates as good or very good in terms of their understanding of the scientific basis of dentistry, awareness of their personal limitations, and awareness of their moral and ethical responsibilities. Responses from graduates generally paralleled those of their employers. The response of employers were consistent with staff evaluations providing some confirmation that the new curriculum is achieving its desired outcomes. More details about outcomes of the evaluation process are included in the Dental School's Teaching Portfolio which can be viewed at <site no longer available, 22/8/06>.

Selected Publications

Townsend GC and Burgess VB (1993) New curriculum developments at The University of Adelaide. Aust Dent J 38: 238-242

Wetherell J, Mullins G, Winning T and Townsend G (1996) First-year student responses to a new problem-based curriculum in dentistry. Aust Dent J 41:351-354.

Townsend GC, Winning TA, Wetherell JD and Mullins G (1997) New Problem-based Learning dental curriculum at The University of Adelaide. J Dent Ed 61: 374-387.

Winning TA, Marriott P, Wetherell JD, Mullins GM and Townsend GC. (1994) Implementing computer aided instruction in a PBL dental curriculum. Research and Development in Problem Based Learning Vol 2 (Ed: Ostwald M and Kingsland A) pp 369-383

Winning, TA and Townsend, GC. (1995) Evaluation of computerized learning packages in a problem-based dental curriculum. J Dent Res 74: 565

 

Contact
Prof Grant Townsend can be contacted on:

Tel: +61 8 8303 5968
Fax: +61 8 8303 3444
E-mail: townsend@dentistry.adelaide.edu.au

Adelaide University, Australia 5005

 

last update 14/8/99